| NPI | 1346630373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1273780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.021209) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2024-07-22 |